Disseminated tuberculosis presenting with finger swelling and skin ulcer: a case report.

Dear Editors, Tuberculosis remains a major public health problem causing significant morbidity and mortality in individuals worldwide. Extrapulmonary tuberculosis has become an increasingly important issue, particularly among immune-compromised patients (1). According to the National Tuberculosis Surveillance System, in the USA, the prevalence of extrapulmonary tuberculosis was reported to increase from 15⋅7% in 1993 to 21⋅0% in 2006 (2). The proportion of extrapulmonary tuberculosis is also increasing in Korea, from 11% in 2004 to 23% in 2011 (3). However, bony lesions found on the hand, foot or leg are still rare presentations of extrapulmonary tuberculosis (4). We report a case of disseminated tuberculosis in a 48-year-old man, whose major complaints were skin ulceration and finger swelling. The aim of this case report was to point out that if non-healing skin lesions or unknown origin of finger swelling is presented, clinicians should take tuberculosis into consideration as a potential diagnosis. A 48-year-old man visited out-patient clinic with complaints of a non-healing skin ulcer on the right medial malleolar area and right-index finger pain with swelling (Figure 1). He remembered minor trauma history on the right medial malleolus 3 months ago and found ulceration a month before. He then visited a local clinic and treated with cefepime for 1 week. Because, there was no improvement, he admitted to the hospital and treated with intravenous ciprofloxacin. Two weeks after admission, his index finger was swollen without any trauma history and then he referred to our hospital. He denied fever, weight loss or other systemic symptoms. On physical examination, his index finger was swollen and erythematous at the middle phalanx. Small ulceration with swelling and heating sensation on